Titans of the ECigarette Debate Clash: ECigarette Summit Review

The e-cigarette summit was a huge success yesterday – congratulations to e-cigarette-forum for organising the summit. I was blown away by the success of it!

I’ve put together this summary for people who are interested but couldn’t attend. In particular, I think it’s important for e-cigarette advocates to understand the debate where it stands. Obviously, you can’t cover everything in a single post, so I’ve focussed on the e-cigarette debate as it stands today rather than the science discussed.

Hope for the Future

In private conversations with activists (some from as far away as Canada and the US) there was a lot of hope for the future. David Sweanor, who we interviewed before here (page since removed), is hopeful of good policy being made here, policy which could influence what happens in the US and Canada, while a UK activist talked of progress being made with UK MPs.

The Main Debate

There was agreement on both sides that electronic cigarettes are almost certainly vastly better than tobacco cigarettes. The differences arise on whether e-cigarettes should be regulated as a medicine or not.

As was pointed out in the conference, this is an important debate, because the Medicines and Healthcare products Regulatory Agency (MHRA) has said that not one current device would be legal under medicinal regulation.

This means that 1.3 million users of electronic cigarettes would have to give up their electronic cigarettes when medicinal regulation comes in. We do not yet know what the alternative will be, but it’s likely to be mass manufactured cigarette lookalikes produced by the major tobacco companies.

The Pro-Medicinal Regulation Argument

1. Effectiveness of E-Cigarettes

Deborah Arnott from Action on Smoking and Health (ASH), argued that e-cigarettes are good, but not yet good enough. Although 1.3 million have successfully switched to e-cigarettes, 2.4 million have tried e-cigarettes but not yet switched.

(Clive Bates, former director of ASH, who we interviewed here) replied that 1.2 million was an incredible success, especially when compared to NRT, and that success does not have to be 100% – different solutions suit different people. Continued innovation, he believes, would lead to more success in the future.)

Deborah and Jeremy Mean from the MHRA both argued that regulation was the answer to this, and Jeremy Mean believed regulation would lead to greater innovation. (Strange for the representative of a Conservative party to favour regulation over competition!)

2. E-Cigarettes not safe enough.

Although e-cigarettes are almost certainly safer than tobacco cigarettes, regulation would ensure e-cigarettes were even safer. Deborah pointed that if there are problems with e-cigarettes, we won’t about know about them for 15 years or more.

3. Regulation will convince users of their safety.

More important, Deboarh argued, is that many users are not convinced that e-cigarettes were better than tobacco cigarettes, with many mistakenly blaming nicotine for the cause of smoking diseases. Regulation would reassure users that e-cigarettes were safe.

4. Could then be recommended under National Institute for Health and Care Excellence (NICE) guidelines.

Currently NICE guidelines can only recommend smoking alternatives that have been licensed, although informally the advice is that if you have switched to ecigs, you should continue using them instead of going back to cigarettes.

5. Can’t trust companies

Deborah argued that companies are profit making machines, with no motive other than to maximise profits. Therefore, the responsibility for safety and efficacy should be handed to the MHRA.

6. Consolidation will happen anyway

Mr Mean and Deborah Arnott appeared to accept smaller companies will be wiped out, but argued that consolidation would take place even if there wasn’t regulation.

7. Need to limit ecigarettes to existing smokers

Deborah was also worried about the potential of e-cigarettes to renormalise smoking (although she did point out that their current research shows that this is not yet a problem) and to act as a gateway to smoking.

In response, it was pointed out (I think by Daz from Vapor Trails among others) that you are not going to stop children/people from using drugs like nicotine, and if they do it is better for them to use e-cigarettes than smoking. One speaker even argued that we should not have age restrictions on e-cigarettes (as NRT aids are available to children anyway.) Clive Bates argued that the amount of lives saves would more than than justify a few new nicotine users.

8. Need Restrictions on Marketing

Deborah Arnott also argued for restrictions on e-cigarettes which would ensure that the adverts target only smokers and are information based.

Clive Bates disagreed, arguing we need effective, fun and sexy advertising that will reach more smokers.

The Anti-Medicinal Regulation Argument

1. Any gain in safety would be offset by the smokers reverting to cigarettes.

As Clive Bates pointed, a huge improvement in the safety of electronic cigarettes would only see safety improving from something like 99% to 99.9%. This is not worth damaging the industry and making ecigarettes less attractive. (I’ve summarised all Clive’s arguments against regulation below this piece.)

However, the loss of innovation, competition and existing devices that meet different needs could see many vapers returning to cigarettes, and fewer smokers switching to e-cigarettes.

2. Free Market and Competition Best Way To Ensure Improvements

Several of the speakers argued that the best way to ensure continuing improvement and innovation is to allow competition. That’s because:

3. Regulation would Stifle Innovation

In contrast, Clive Bates, regulation would freeze development where it is now. Innovative companies would be wiped out, and companies currently regulated by the MHRA have shown an inability to innovate, to produce exciting products or to create the internet buzz that exists around e-cigarettes.

Many companies would be wiped out, and the cost and beauracracy of applying for medicinal regulation (one application can be ten thousand pages long) would discourage companies from applying for licenses for new products.

3. Cost of Regulation

Katherine Devlin (who we interviewed here) of ECITA said that ECITA’s case studies showed that the cost of applying for regulation could be as much as the whole value of the e-cigarette industry.

Mr Mean apologised and said that he did not yet have enough information to provide estimates of costs.

5. Regulators Don’t Understand E-Cigarettes

Dr Konstantinos (interviewed here and here) argues that “The MHRA do not understand the e-cigarette,” seeing it simply as a nicotine delivery device (a medicine) when it is far more than that for most vapers.

Perhaps Mr Mean made this point for him when he said that vapers don’t need the next new flavour, they just need a device which will delivery a droplet of nicotine to the lungs (although scientists like Murray Laugesen believe e-cigarette users probably absorb nicotine in their upper airways passages rather than in their lungs).

6. Regulations Can Not Cover All Devices

David Dorn from Vaper Trails TV made this point very well by asking all vapers to hold up their e-cigarettes – a huge range were displayed.

As David pointed out, these different devices satisfy the needs of different users. We already know that cigarette users as well as e-cigarette users use their devices in very different ways. Given the cost and bureaucracy involved in medical regulation (and the fact that all 1,300,000 vapers would see their current devices confiscated) how can regulation meet all vapers needs?

7. Regulation is Probably Illegal

The EU’s legal committee has already ruled that a medicinal ban would be illegal, and in countries where medicinal regulation has been introduced the courts have ruled against it.

8. The Black Market and DIY

“You can not stop a tsunami with a law,” Dr Etter argued, before pointing out that the e-cigarette revolution would take place without, or possibly despite, the MHRA.

Dr Etter wasn’t the only one who believed that medical regulation would lead to a thriving black market in the devices and liquids which would be banned under the MHRA, with a likely decrease in quality and nicotine produced in sheds (actually, Clive Bate thought it wouldn’t be that dangerous.)

Mr Mean argued that because there was not a black market for medicines such as aspirin, there would not be a black market in ecigarettes/ejuice. I think this again shows he fundamentally misunderstands the e-cigarette market.

9. You can’t trust the MHRA

Just as Deborah argued we can’t trust private companies, one retailer argued we can’t trust the MHRA.

90% of the MHRA’s funding comes from pharmaceutical companies, and, as we have pointed out in the past, some MHRA employees continue to receive funding from pharmaceutical companies. A House of Common’s report in the past has highlighted undue influence from the pharmaceutical companies.

10. Concern is coming from a very small number of public health professionals

Clive Bates argued that the e-cigarette had been very disruptive to those who make their living from public health, and that most opposition was coming from them.

These people, he believed, were “clutching at hypothetical straws.”

Clive Bates: The Price of Regulation

Clive summarised the cost of regulation as follows:

Increased cost

Reduced Appeal

Decrease in Variety

Decrease in Innovation

Fewer, duller innovations

Decrease in personalisation

Boring branding and marketing

Trusted brands and firms destroyed

Oligopoly and reduced competition

Black market and DIY

The Art of the Possible and a Possible Compromise

As Lib Dem EU MEP Rebecca Taylor pointed out, we have to compromise and work with the art of the possible.

With broad agreement among all speakers that e-cigarettes are an incredible opportunity for public health, I wonder if our speakers could get together and work on two tier approach to licensing.

One tier would allow licensing of some devices, which would reassure users buying them that they are safe.

Another tier would allow existing smaller companies to continue to innovate and allow devices which meet a wider variety of needs without the regulation that would effectively ban them.

A Huge Debt of Gratitude

Dr Polosa (interviewed here and here) pointed out to me that in addition to carrying out a lot of unpaid work, many scientists are risking their careers when they support e-cigarettes.

That’s because their research does not support the established tobacco control view, an establishment which controls research funding.

I am personally hugely grateful that these scientists have prioritised our health over their careers!

Once again, thanks also to e-cigarette-forum for funding and organising a fantastic conference!

Update: I’ve just noticed that Chris Snowden has also blogged on the e-cigarette summit – it’s a good read from a totally different angle, so check it out here. If you know of any other good posts, please leave a link in the comments.

Update 2 – Slides Now Available: E-Cigarette Forum has now posted the slides used by the speakers the event here.

Main blogger at the Ashtray Blog, co-author of a University of Alberta study of "Electronic cigarettes as potential harm reduction products", co-author of the book: "Electronic Cigarettes: What the Experts Say." Works at ecigarettedirect.co.uk.

Thanks for the overview, James. Even the media have managed to come out with some positives in their reporting, with headlines saying that “Electronic cigaretts could save millions of lives” – which makes a VERY refreshing change.

One thing does take my breath away though – this character Jeremy Mean. Just exactly which planet does he come from? And who on earth hired him to have anything useful to say concerning… well, anything, really? He thinks there isn’t a black market for aspirins and he’s probably right. But if he thinks the same applies to other pharmaceuticals someone really ought to put him in the picture pronto. Fake Viagra, anyone? Try asking the Yanks about Vicodin, for example. Or even the students popping “smart drugs” at some of our finest universities, apparently.

This man is either so foolish he’s dangerous, or he hasn’t left the lofty heights of MHRA Towers and noticed anything that’s been happening out in the real world anytime in the past couple of decades. Is he even aware of the already thriving black market in cigarettes and tobacco? Still I guess if any evidence were required that the MHRA has outlived it’s usefulness in it’s present form, that would do nicely…

To Jeremy Mean’s credit, at least he came to the conference and presented his point of view, instead of trying to have the conference cancelled like some of the tobacco control people. I have a feeling he has been given a position to communicate, whether he agrees with it or not.

That said, one point that astounded me was that he said the MHRA had always been willing to listen and find the best solution for e-cigarettes. It’s not that long ago the MHRA were recommending that e-cigarettes be pulled from the market in 21 days (and if Labour had won the election they probably would have been.) Now they are admitting that ecigs will save millions of live, but that claiming it is best done under their control. Given their history, it’s not surprising that they have not gained the trust of vapers.

“Given their history, it’s not surprising that they have not gained the trust of vapers.”

James, yes! Exactly the point I made in a more extended fashion below. Antismokers and Antivapers tend to be “End Justifies The Means” sort of thinkers: they won’t hesitate for a moment to jiggle, juggle, and twist anything in sight in order to further their ultimate goals.

Sounds like it was a fairly good discussion/conference overall, though with some weak points. E.G. “Mr Mean argued that because there was not a black market for medicines such as aspirin, there would not be a black market in ecigarettes/ejuice.” This reminds me of my postings about the the huge black market in smuggled broccoli. Oh, wait… there isn’t one. Why? Because there aren’t criminal levels of taxation on broccoli. If e-cig regulations raised the prices to unreasonable levels then there would most *certainly* be a black market, and the black market juices and devices would almost certainly be less safe than what’s currently on the market.

The problem with regulation is that too many of the people who are pushing the hardest for it aren’t trustworthy. They will try to use regulation as strangulation. In *theory* a well-designed minimum level of safety regulation dealing with purity of product just the e-liquids and safe design for the e-cigarettes themselves would be wonderful. In *practice* we know the problems that opening the barn door a little crack can bring.

Let’s see the powers-that-be return the regulation of cigarettes themselves to some reasonable semblance of rationality by allowing consenting adults to gather in clubs and pubs that are specifically designated as allowing smoking, and then perhaps I’d trust them to behave responsibly in the field of e-cig regulation. Without that show of good faith, I’d say the best course of action is to fight them tooth and nail every inch of the way.

I don’t seem to understand Ash’s seemingly non adjustive, puritanical stance, they have moved their remit from anti-tobacco to anti-nicotine it would seem and whilst there was plenty of evidence to say tobacco burning was harmful, there just isn’t the same evidence out there that pure nicotine, the same nicotine we consume in our carrots and peas, is harmful to us to any degree.

And I suspect a lot of this crowing is coming about as governments realise that whilst cigarettes evolved into the 21st century, they missed out on a massive taxation bounty that if they were quicker off the mark, could have legislated and brought the whole thing under their commercial control but now any attempt to do so would receive fierce resistance from the EU and the public too.

Too many vested interests polluting the water here, governments need us to smoke high tax cigarettes to make the books balance, a move from that eats into their revenues, they in turn are hand in hand with either big pharma or big tobacco and I am still trying to find the economical logic of the NHS handing out hundreds of pounds worth of patches, sprays and gum to people who tell them they don’t work, the NRT market must be worth billions in the UK alone and big pharma is going to protect that nest egg ferociously.

I would like to see a blue sky decision sometime soon where the NHS offer NRT OR a disposable e-cig, even if its a Vype Reloaded to keep BAT happy, one cheap Chinese disposable e-cig will still cost a fraction of what a box of patches cost so why are we not delivering best value for money to the taxpayer? Imagine how cheaply the government could get these if they solicited contracts to supply?

But it does seem that the e-cig is here to stay, I am glad that the no choicers didn’t win on this as really it is all about choice, not the hobson choice we get from HMG.

Thanks for the comment. I am inclined to take the tobacco tax argument more seriously following what has happened in Italy. Following ecigs introduction cigarette consumption dropped by 8% – all the years of tobacco control had never achieved anything like that. So the government has responded with a massive tax on electronic cigarettes, which has crushed the e-cigarette industry.

As for ASH England, they used to be pro-alternatives (like Snus) although that was probably Clive Bates influence.

hehe the good ol’ Snu’s, wasn’t that one of the last Esther Ranzten campaigns to stop Skoal Bandits from selling to kids way back in the mists of time?

HMG is being particularly lethargic with any form of taxation which I suppose is brought about by the considerably low sales and lack of health issues which they could base their taxations on, legislation wise it would be chaos as HMG would have to ban all sales wholesale and otherwise from China and Hong Kong and then come up with a viable reason as to why they must tax UK or EU made items.

And what of home made machines? I could viably make a battery compartment out of an old metal torch tube, atomisers aren’t that hard to self build either, will we see criminalisation of people who choose not to follow the government set lead? Will we need licences to buy fusewire and cotton wool next? I think the government will look pretty silly all in all but we don’t really know what their thinking is as there seems to be none other than the set thought of 6mg strength max and no flavourings in the vain hope we would all give up trying to get anything out of what would be a wet electronic silk cut and as much flavour or fun as wet cabbage.

One thing some certain unknown quarters did do was scare the courier companies into refusing to carry anything with Lithium batteries in or has e-juice in, this caused chaos with the Chinese suppliers this last month with Hong Kong post hurriedly posting new rules out of nowhere that all export parcels had to be x rayed for lithium batteries and canisters of tobacco liquids, the Chinese are rightfully somewhat vexed at this and believe it was done by big Tobacco and/or anti tobacco lobbies somehow sexing up the exploding battery myth to the point of hysteria.

Currious , given that lithium batteries are in so many consumer products, are there rules about their transport, in general? (In Australia they must be carried as cabin luggage , not put into the hold.)

Hi James.
If the govt slapped a hefty tax on ecigs here there would be an even heftier black market to counter it! And anyway, how could they possibly justify it when the reason for such high tax on tobacco was to stop people smoking for their health and the costs to the nhs for treatment?? (Just realised I used past tense there-as if no one smokes anymore) truth is they are running scared at the potential and currently growing loss to their coffers, along with big pharma and the tobacco industry. Full stop!

I don’t think the tax would come from the UK, but from the EU, where unfortunately it is already being discussed. There is no ethical justification. According to one speaker several tens of thousands of vapers are already ready to revert to the black market.

One possible way would be to stipulate that stuff which is to be sold freely in supermarkets and other venues must be regulated, while stuff sold over the internet wouldn’t need that regulation.
In practice, this would probably mean regulation for cigalikes and pre-filled cartridges, while more serious vaping equipment (egos and upwards), together with mixed juices, and mix-you-own stuff, could be allowed to remain unregulated. One argument for this solution could be that things sold in shops are more easily accessible and can be bought anonymously, while sales over the internet require more initiative from the purchaser and aren’t anonymous, as buyers are identifiable (via credit cards and/or PayPal etc) and have to supply a physical address.

That internet sales have registered buyers, can be a strong argument, as it means that that if product problems arise, such buyers can be easily reached and warned.

At the same time, regulation of the cigalikes in physical shops, would mean that the shop owners wouldn’t risk being held responsible if problems arose from the products they sell, thus making them more willing to sell and display the products.

Yes, such a solution would unfortunately put a stop to the possibility of exciting vape shops on the high street, where we could look at and try out new kits, but it would at least be better than strict and expensive regulation of everything. And if the internet shops were allowed to market themselves, it should be fairly easy for beginners who have started with cigalikes, to start buying more gratifying things over the net.

1. They reach people that the internet doesn’t reach – we find we are selling to a completely different demographic on the high street.

2. Consumers have a much greater chance of success with second generation devices when they buy from specialised shops, because they have trained staff to demonstrate how to use the device, and because they can come back for additional support if they have any problems.

Plus, we find there is very little interest in cigalikes in the shops, almost all customers go straight for second generation devices after trying out the different devices.

I agree that it would be great to have specialised shops and all their advantages, but if juice and higher end equipment can be protected from regulation by remaining in the e commerce market and thus at least have the appearance of being less accessible for youngsters, it may be worth it.
Considering the enormous amount of variables in the market above the cigalikes and pre-filled cartridges, regulation would become an absolute nightmare if introduced there. In fact, that whole segment of the market could be banned, as each possible combination of battery, atomiser and liquid can’t be tested and approved, especially not if people are allowed to do their own mixes.

They would be banned, I have just been looking at the costs now as preparing for a meeting with a parliamentary researcher, and the costs of medical licensing for all devices would be more than the entire turnover of the industry.

Something that is being overlooked in this discussion is, China. China has a lot of smokers and the smoking related health care issues, are big.
E-cigs are effectively a Chinese innovation and are a significant improvement re health care costs for china.
Would be a bit surprised if China, is about to stop making and exporting ecigs, regardless……

Regulating something that does not have to look like anything in particular batteries and small heating coils can come in just about any shape you want), doesn’t even necessarily contain nicotine or have any particular smell , something that doesn’t burn anything….. legislatively a nightmare nonsense.

I was considering myself actually going to the markets with a stall and a lively stock of goodies but when I approached the local council to enquire I was told I wouldn’t be allowed to as it is classed as a tobacco product, needless to say after half an hour wrangling that position didn’t change either 🙁

Yet reading through their rules and speaking to other traders, there isn’t actually any rules whatsoever about tobacco with this council and I suspect the person was making it up as they went along with something that sounded plausible, really annoyed though as I could have caught the Xmas rush.

“One argument for this solution could be that things sold in shops are more easily accessible and can be bought anonymously, while sales over the internet require more initiative from the purchaser and aren’t anonymous, as buyers are identifiable (via credit cards and/or PayPal etc) and have to supply a physical address.”

Over here we have the PACT Act: “Prevent All Cigarette Trafficking” (as in drug trafficking!) with the focus (excuse) on preventing children from using their credit cards to order cigarettes without having to show proper age ID cards. That would simply be extended to e-cigs and supplies. Actually even more easily perhaps, since the e-liquids could more easily be consumed as “poisons” than regular cigarettes. (Yes, of course we both know that the children can buy Drano, bleach, aspirin, etc etc — but rationality and consistency were never the strong suit of the Antismokers.) I don’t know if that sort of thinking has jumped over there yet, has it?

That being said, there are some strange loopholes in the PACT Act here: I believe you can still buy rolling tobacco and (within limits) cigars over the internet.

PACT has fortunately no equivalent on this side of the Atlantic – and credit cards basically don’t exist among children here (contrary to the practice in the US, credit card accounts are strictly personal in most European countries, so several family members can’t share the same account – and in order to have your own account you have to be 18).
But even in the US, PACT can’t apply to ecigs and ejuice unless that law is changed or ecigs are defined as cigarettes.

Unfortunately, in the US ecigarettes have already been defined as a tobacco product in the NJOY v. The FDA case. As the time this saved the ecigarette industry as the FDA was attempted to regulating it as a medicine, but it may have unfortunate consequences, for an example an extension of the strict tobacco testing regime from that is being rolled out for the tobacco cigarettes, which would probably destroy the second generation electronic cigarette industry.

For a good chunk of the Antismoking community, the sole intention behind regulation is to destroy the vaping industry. If they can do it by classifying it as a medicine, as a tobacco product, or as green cheese from the Moon, they’ll go for it.

The vaping community should be developing and then pushing hard for a clear cut, reasonable, safety/quality-oriented form of regulation and dig in its heels and absolutely refuse to compromise if anything beyond that is proposed.

Compromise is fine, as long as it is *reasonable* — but I cannot see *anything* beyond that basic quality/safety regulation as being reasonable.

Never forget the step-by-step strategy that was used against smokers and the tobacco companies and how successful it’s been: the same tactics will be used against vapers.

There is strong resistance about, America seems to be a little ahead of Europe in some states where it is allowed, some of the outlets in California are huge and carry huge variety as well, whilst small chains and single outlets is what we have here.

And you mention the tactics used against smokers, I am quite miffed at that instance, to date, with the best scientists and health professionals at it for 40 odd years they still cannot prove or identify a link from tobacco smoking to cancers and heart disease and I have long thought that tobacco has become the ready whipping post for all ills as studies into air pollution by aircraft is buried, stalled and prevented by the government as some scientists did point out that smokers in rural areas lived longer healthier lives than smokers in cities and so they suggested that some of the health issues may not after all be smoking related but were soon silenced.

Ian the landmark conclusive study on ‘Smoke..ing’ was published in about 1957.

The really sad thing is that the first patent for a e-cig was back in the 60s. The guy who invented the concept understood clearly that the issue was burning tobacco and the answer was making a vapor that contained no combustion products.

Personally I think that the real reason for the health authorities panic about ecigs replacing smoking , is that they would lose their reason for feeling smugly superior. 🙂

My holiday was in France this year it was very noticeable that everywhere – even in very small villages – there were eCigarette shops lots of them!!!(much like this country with £shops, betting shops and loan companies that seem to be taking over the high street) the French seem to have taken to vaping big time 🙂

For a good chunk of the Antismoking community, the sole intention behind regulation is to destroy the vaping industry. If they can do it by classifying it as a medicine, as a tobacco product, or as green cheese from the Moon, they’ll go for it.

The vaping community should be developing and then pushing hard for a clear cut, reasonable, safety/quality-oriented form of regulation and dig in its heels and absolutely refuse to compromise if anything beyond that is proposed.

Compromise is fine, as long as it is *reasonable* — but I cannot see *anything* beyond that basic quality/safety regulation as being reasonable.

Never forget the step-by-step strategy that was used against smokers and the tobacco companies and how successful it’s been: the same tactics will be used against vapers.

“For a good chunk of the Antismoking community, the sole intention behind regulation is to destroy the vaping industry. If they can do it by classifying it as a medicine, as a tobacco product, or as green cheese from the Moon, they’ll go for it.”

That’s essentially the same point that Clive Bates made at the ECigaretteSummit.

“The vaping community should be developing and then pushing hard for a clear cut, reasonable, safety/quality-oriented form of regulation and dig in its heels and absolutely refuse to compromise if anything beyond that is proposed.”

That’s exactly what our industry body, ECITA, has been doing – their Industry Standard of Excellence, which has been called a standard any industry would be proud to have by a trading standards officer, goes beyond the legal requirements and includes mandatory testing of eliquid by members for impurities and nicotine content.